Splenic pathologies appearing as hypodense lesions on CT images are
presented, emphazising the importance of evaluating such lesions in the
clinical context. While most such lesions are benign, familiarity with
the imaging findings aids in identifying those warranting closer
attention.

Teaching Points:

Haemangiomas, congenital in origin, represent the most common benign lesions of the spleen.

Lymphoma represents the most common malignant tumour of the, usually secondarily involved, spleen.

Most hypodense splenic lesions on CT represent benign lesions that require no further work-up.

For correct interpretation, hypodense splenic lesions need to be evaluated in the clinical context.

Abstract:Background: As the largest single lymphatic organ in the human
body, the spleen is responsible for central immunological and
haematological tasks. Therefore, the spleen can be subject to a wide
range of pathologic disorders. Computed tomography (CT) represents the
most widely applied cross-sectional abdominal imaging technique and is
considered the imaging modality of choice for the evaluation of numerous
abdominal pathological conditions. Hypodense splenic lesions are
frequently encountered on abdominal CT images. Although most hypodense
lesions of the spleen can be considered benign, some findings and
clinical conditions warrant closer attention to the lesion. CT offers a
number of morphological criteria that can be applied to differentiate
hypodense lesions of the spleen, such as a the appearance of a lesion’s
borders, its attenuation, as well as the presence of calcifications or
solid components.Methods: This article reviews the most common splenic pathologies
leading to hypodense appearances on CT images and illustrates the key
CT imaging findings in the context of the clinical history of the
patients.Conclusion: The key imaging findings of hypodense splenic lesions
are presented in order to aid interpretation during routine evaluation
of abdominal CT images.